Summary of the CORTICUS Trial (Sprung 2008)
Hydrocortisone therapy did not improve outcomes among patients with septic shock (onset within 72 hours), although it did shorten the duration of vasopressor dependence.
Summary of the Annane 2002 Trial
Among patients with very early septic shock who were non-responders to a cosyntropin stim test, hydrocortisone/fludrocortisone therapy improved 28-day survival. Furthermore, steroid therapy reduced duration of vasopressor therapy in all patients (regardless of stim test response).
Summary of the NICE-SUGAR Trial
Among critically ill patients, intensive glucose control increased 90-day mortality and the incidence of severe hypoglycemia compared to conventional therapy.
Summary of the Leuven I (van den Berghe 2002) Trial
In surgical ICU patients (primarily cardiac), intensive insulin therapy reduced ICU mortality, renal impairment, and bloodstream infections. The rate of severe hypoglycemia was higher with intensive insulin.
Summary of the NINDS Trial
In patients presenting within 3 hours of ischemic stroke, alteplase improved 3-month neurological function (NNT=9) but did not impact 24-hour symptoms or mortality. In patients receiving alteplase, approximately one-quarter had minor bleeding, and 6.4% had symptomatic ICH (NNH=17).
Summary of the Kress 2000 Trial
Medical ICU patients receiving continuous infusion sedation with daily interruption were liberated from mechanical ventilation and left the ICU quicker, but this effect did not translate to a shorter hospital course or a mortality benefit.
Summary of the EPaNIC (Casaer 2011) Trial
Early initiation of TPN increased ICU and hospital stay, the incidence of infection, and total healthcare costs. Delaying parenteral nutrition up to 7 days had no effect on mortality.
Summary of the Rivers 2001 Trial
Protocolized early goal-directed therapy initiated in the ED in severe sepsis and septic shock patients improved resuscitation parameters and reduced mortality.
Summary of the SOAP-II (De Backer 2010) Trial
Among patients with all types of shock, mortality rates were not different between norepinephrine and dopamine, although norepinephrine was more effective as a vasopressor and was less associated with arrhythmias. Norepinephrine may have a mortality benefit over dopamine in a subset of patients with cardiogenic shock.
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Summary of the ANZICS Dopamine (Bellomo 2001) Trial
The use of “renal dose” dopamine did not reduce peak creatinine, the need for renal replacement therapy, ICU length of stay, or mortality.